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1203 Grouphome
Intellectual Disabilities Intermediate Care Facility in Mandan, North Dakota
NPI 1407153059

1203 Grouphome is a Intellectual Disabilities Intermediate Care Facility based in Mandan, ND. 1203 Grouphome practices in Mandan, ND. The NPI Number for 1203 Grouphome is 1407153059 and holds a License No. (North Dakota).

The current practice location address for 1203 Grouphome is 1203 7Th Ave Se, Mandan, ND and can be reached out via phone at 701-667-6168.

Location: 1203 7Th Ave Se, Mandan, ND, 58554-3135
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1407153059
Provider Name
1203 Grouphome
Credential
Provider Entity Type
Organization
Address
1203 7Th Ave Se, Mandan, ND, 58554-3135
Phone Number
701-667-6168
Fax Number
Provider Enumeration Date
02/17/2011
Last Update Date
05/18/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
30878 05 ND
institution
Provider Business Practice Location Address Details
Address
1203 7Th Ave Se
City
Mandan
State
North Dakota
Zip
58554
Phone Number
701-667-6168
Fax Number
person
Provider Business Mailing Address Details
Address
1203 7Th Ave Se
City
Mandan
State
North Dakota
Zip
58554
Phone Number
701-667-6168
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
()
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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